At the present time the cesarean section is one of the most widely used surgical procedures. A cesarean section is a major surgical procedure in which a baby is removed from the uterus by making a cut into the abdomen and then into the uterus. In many cases, a cesarean section is necessary to save the life of the baby or the mother. In other cases, a cesarean section is performed when a vaginal birth is not possible, e.g., failure of normal progression of labor. In some other cases, a cesarean section may be scheduled due to a patient's request, or recommended by another doctor.
The cesarean section begins with an incision or cut on the skin. This cut is carried deeper until the abdomen is completely open (into the peritoneal cavity). The bladder, which is normally attached to the front of the uterus, is released. This is done by cutting the attachments of the bladder to the uterus and pushing it away. A cut is then made in the uterus. This cut is then carried deeper until the uterine wall is completely divided. The uterine incision is then extended by tearing the tissue or cutting it with a sharp scissor. The amniotic cavity, a baby sac with its surrounding fluid (“waters”) is opened. The baby is then delivered and handed to the pediatric or baby care team. The after-birth, or placenta, is then removed. The incision is then closed.
One of the biggest problems related to a cesarean section is blood loss. The average blood loss is about 1000 ml. It is about two times larger than during a vaginal delivery. It can cause serious morbidity and mortality and the problem of hemorrhage is well-described in multiple studies.
Every woman would benefit from lower blood loss during a cesarean section. Low blood loss is particularly important in the situations where blood is not available or the patient does not want to accept blood transfusion (like Jehovah witnesses). There are many procedures and instruments developed with intention to correct severe blood loss—most of them used after blood loss occurred.
The methods and instruments used for non-permanent occlusion of uterine arteries are described in U.S. Pat. Nos. 6,254,601, 7,329,265, 7,354,444, and U.S. Pat. Appl. Nos 2006/0178698, 2007/0203505.
A method for performing a cesarean section usually comprising the following steps:
a) skin incision,
b) uterine incision,
c) delivering the baby,
d) delivering placenta,
e) pulling the uterus out from the pelvic cavity and placing the uterus on the patient abdomen,
f) suturing the uterus,
g) closing the patient.
The time of suturing of the uterus depends on the rate of its bleeding. The more uterus incision bleeds, the more time is needed to suck the blood by sponges and suture the uterus. The bleeding has to be stopped so that the surgeon can see clearly the area to be sutured. Even though the time of the suturing of the uterus is relatively short (about 5-10 minutes), the patient could lose a significant amount of blood just during the suturing of the uterus alone.
To stop the bleeding, physicians are currently using the uterine artery occlusion, either temporary or permanent. Permanent occlusion utilizes particles injected in the uterine arteries. It is expensive process, has to be planned in advance and is time consuming. Due to expense and invasive nature of the procedure, it has a very limited application. Placing the uterine artery balloon is a temporary procedure, but is still limited by the cost and invasive nature of the procedure.
There is a known clamp for occlusion of uterine arteries during hysterectomy. Such clamp is shown at TeLinde Operative Gynecology, auth: John A Rock, editor Howard W Jones, publisher: Lippincott Williams & Wilkins, 9th edition, 2003, FIG. 19-13 A-C, page 622.
A. “The ascending branches of the uterine artery are clamped, cut, and suture is placed just below the tip of the clamp and immediately next to the uterine wall.
B. After removing the clamp, the suture is tied, thus securing the vessels before they are cut.
C. The pedicle is regrasped just above the tie and then doubly ligated.”
However, these clamps could not be used for occlusion of the uterine arteries during a normal cesarean section where there is no need for a hysterectomy for a number of reasons. The clamp damages the uterine arteries and damage during cesarean section could be life threatening. The profile of the clamp does not fit the abdomen of the patient during cesarean section. Also, during a cesarean section, at the end of pregnancy the uterine vessels are much large than before pregnancy. For example, the width of both an artery and vein exposed after pulling the uterus out from the pelvic cavity and placing the uterus on the patient abdomen can be 40 mm or even more. Since it is difficult to occlude an artery only, the clamp has to occlude both the uterine artery and the vein which goes along the artery. There is no clamp which could do it without damaging the blood vessels. Therefore, there is a need for a simple, convenient, fast, harmless for a fetus and the blood vessels, inexpensive method and instrument that can be applied right during the cesarean section surgery that would significantly reduce blood loss.